This 8-year-old cat presented with a 6-week history of sneezing and 1-week history of right-sided facial swelling. Diagnostic testing revealed chronic kidney disease, hyperglobulinemia, and neutrophilia. CT imaging showed a soft tissue mass filling the right nasal cavity and bone lysis. Rhinoscopy and nasal biopsies found marked neutrophilic rhinitis on the right and mild rhinitis on the left, with no evidence of neoplasia or fungi. Abdominal ultrasound showed shrunken kidneys consistent with chronic kidney disease. The facial swelling is likely due to a chronic, non-neoplastic rhinitis, though a secondary bacterial infection cannot be ruled out
- An 18-month old female Savannah cat presented with 2 weeks of progressive ataxia and reduced appetite. Physical examination revealed vestibular syndrome and pyrexia. Bloodwork and additional testing ruled out several potential causes. Abdominal ultrasound found an effusion that tested positive for feline coronavirus via PCR. Despite negative coronavirus results on the fluid, FIP remained the most likely diagnosis given the signalment, clinical signs, and fluid analysis findings. The cat was started on remdesivir and showed rapid neurological improvement, supporting a presumptive diagnosis of FIP.
A 2-year-old male Springer Spaniel presented with a 3-month history of intermittent, unilateral epistaxis and occasional cough that had not responded to previous treatments. Clinical examination revealed pale mucous membranes, tachycardia, and a small amount of blood in the right nostril. Diagnostic testing showed a regenerative mild anemia, mild thrombocytopenia, and strong positive results for Angiostrongylus vasorum on antigen testing and fecal examination. Fresh frozen plasma was administered and anthelmintic treatment was started. The epistaxis resolved within 24 hours and hematological parameters normalized over 2 weeks, confirming angiostrongylosis as the cause of the bleeding disorder and clinical signs
This 2-year old female dog presented with a 2 day history of hind limb lameness and a 3-4 week history of progressive skin nodules. Physical examination revealed multiple small skin nodules, joint effusions, and enlarged lymph nodes. Testing showed a mild non-regenerative anemia, hyperglobulinemia, and positive results for Leishmania on blood PCR. The dog was diagnosed with leishmaniasis based on clinical signs and test results. Treatment was started with miltefosine and allopurinol.
- The document discusses lupus nephritis, its incidence, presentation, pathogenesis, classification, and management.
- Renal biopsy is important for assessing disease activity and chronicity to guide treatment, which typically involves immunosuppressants like mycophenolate or cyclophosphamide combined with corticosteroids.
- Prognosis depends on the WHO classification - classes I-II have excellent prognosis while classes IV-VI have poorer renal outcomes if not treated aggressively.
This document describes the case of a 22-year-old female patient who presented with fever, difficulty opening her mouth, ear discharge, oral ulcers, breathing difficulties, and cough after a recent tooth extraction. Testing showed sinusitis, oral candidiasis, low lymphocyte counts, and elevated inflammatory markers. A CT scan found lung lesions and the patient was diagnosed with Wegener's granulomatosis based on a positive C-ANCA and lung biopsy showing necrotizing vasculitis. Treatment with steroids and rituximab led to improvement of symptoms. Wegener's is a rare autoimmune disease characterized by necrotizing vasculitis affecting the respiratory tract and kidneys.
A 9-year-old girl presented with 15 days of fever and lymphadenopathy. Initial workup revealed elevated inflammatory markers but negative tests. She remained febrile with worsening lymphadenopathy over two weeks. Bartonella henselae serology was strongly positive, confirming cat scratch disease. Imaging found disseminated liver involvement and bone lesions. Antibiotic treatment with azithromycin, rifampin, and gentamicin resolved her symptoms over 6 weeks. The case highlights the importance of considering Bartonella in cases of persistent fever and lymphadenopathy, and ensuring disseminated infection is ruled out if initial testing is positive.
The 9-year-old cat presented with a progressive hind limb mass, weight loss, pyrexia, heart murmur, and harsh lung sounds. Diagnostic testing revealed abnormalities consistent with disseminated mycobacterial infection involving the lungs, liver, kidneys, and bones. Acid-fast bacilli were identified on cytology of an aspirated kidney lesion, and subsequent PCR and culture confirmed Mycobacterium bovis infection. The cat responded well to antimicrobial therapy but later developed oral squamous cell carcinoma requiring euthanasia.
This document discusses a case of a 58-year-old woman presenting with recurrent eye pain and redness in both eyes. On examination, she was found to have diffuse anterior scleritis in the right eye and posterior scleritis, with a history of rheumatoid arthritis. The document then provides an overview of scleritis, including classification, pathogenesis, diagnostic approach, and treatment strategies depending on the type of scleritis and any underlying conditions. Treatment may involve NSAIDs, corticosteroids, immunosuppressants like methotrexate, or biologics, sometimes with surgical intervention for necrotizing scleritis. Non-infectious scleritis can indicate serious systemic diseases.
- An 18-month old female Savannah cat presented with 2 weeks of progressive ataxia and reduced appetite. Physical examination revealed vestibular syndrome and pyrexia. Bloodwork and additional testing ruled out several potential causes. Abdominal ultrasound found an effusion that tested positive for feline coronavirus via PCR. Despite negative coronavirus results on the fluid, FIP remained the most likely diagnosis given the signalment, clinical signs, and fluid analysis findings. The cat was started on remdesivir and showed rapid neurological improvement, supporting a presumptive diagnosis of FIP.
A 2-year-old male Springer Spaniel presented with a 3-month history of intermittent, unilateral epistaxis and occasional cough that had not responded to previous treatments. Clinical examination revealed pale mucous membranes, tachycardia, and a small amount of blood in the right nostril. Diagnostic testing showed a regenerative mild anemia, mild thrombocytopenia, and strong positive results for Angiostrongylus vasorum on antigen testing and fecal examination. Fresh frozen plasma was administered and anthelmintic treatment was started. The epistaxis resolved within 24 hours and hematological parameters normalized over 2 weeks, confirming angiostrongylosis as the cause of the bleeding disorder and clinical signs
This 2-year old female dog presented with a 2 day history of hind limb lameness and a 3-4 week history of progressive skin nodules. Physical examination revealed multiple small skin nodules, joint effusions, and enlarged lymph nodes. Testing showed a mild non-regenerative anemia, hyperglobulinemia, and positive results for Leishmania on blood PCR. The dog was diagnosed with leishmaniasis based on clinical signs and test results. Treatment was started with miltefosine and allopurinol.
- The document discusses lupus nephritis, its incidence, presentation, pathogenesis, classification, and management.
- Renal biopsy is important for assessing disease activity and chronicity to guide treatment, which typically involves immunosuppressants like mycophenolate or cyclophosphamide combined with corticosteroids.
- Prognosis depends on the WHO classification - classes I-II have excellent prognosis while classes IV-VI have poorer renal outcomes if not treated aggressively.
This document describes the case of a 22-year-old female patient who presented with fever, difficulty opening her mouth, ear discharge, oral ulcers, breathing difficulties, and cough after a recent tooth extraction. Testing showed sinusitis, oral candidiasis, low lymphocyte counts, and elevated inflammatory markers. A CT scan found lung lesions and the patient was diagnosed with Wegener's granulomatosis based on a positive C-ANCA and lung biopsy showing necrotizing vasculitis. Treatment with steroids and rituximab led to improvement of symptoms. Wegener's is a rare autoimmune disease characterized by necrotizing vasculitis affecting the respiratory tract and kidneys.
A 9-year-old girl presented with 15 days of fever and lymphadenopathy. Initial workup revealed elevated inflammatory markers but negative tests. She remained febrile with worsening lymphadenopathy over two weeks. Bartonella henselae serology was strongly positive, confirming cat scratch disease. Imaging found disseminated liver involvement and bone lesions. Antibiotic treatment with azithromycin, rifampin, and gentamicin resolved her symptoms over 6 weeks. The case highlights the importance of considering Bartonella in cases of persistent fever and lymphadenopathy, and ensuring disseminated infection is ruled out if initial testing is positive.
The 9-year-old cat presented with a progressive hind limb mass, weight loss, pyrexia, heart murmur, and harsh lung sounds. Diagnostic testing revealed abnormalities consistent with disseminated mycobacterial infection involving the lungs, liver, kidneys, and bones. Acid-fast bacilli were identified on cytology of an aspirated kidney lesion, and subsequent PCR and culture confirmed Mycobacterium bovis infection. The cat responded well to antimicrobial therapy but later developed oral squamous cell carcinoma requiring euthanasia.
This document discusses a case of a 58-year-old woman presenting with recurrent eye pain and redness in both eyes. On examination, she was found to have diffuse anterior scleritis in the right eye and posterior scleritis, with a history of rheumatoid arthritis. The document then provides an overview of scleritis, including classification, pathogenesis, diagnostic approach, and treatment strategies depending on the type of scleritis and any underlying conditions. Treatment may involve NSAIDs, corticosteroids, immunosuppressants like methotrexate, or biologics, sometimes with surgical intervention for necrotizing scleritis. Non-infectious scleritis can indicate serious systemic diseases.
Tuberculosis of the spine is the likely diagnosis here. The incubation period is usually 2 years. The commonest site is the thoracolumbar area which is an area of maximum stress and has valveless venous drainage.
- An 8-year-old male presented with dark brown urine, facial puffiness, abdominal pain, back pain, and decreased urine output over the past 2 days. Exam found mild periorbital edema and diffuse abdominal tenderness.
- Based on the history of a recent sore throat and positive streptococcal infection markers, the most likely diagnosis is poststreptococcal glomerulonephritis (PSGN).
- Investigations to consider include a complete blood count, basic metabolic panel, urinalysis with microscopy to look for red or white blood cell casts, and measurement of complement levels C3 and C4.
This document discusses systemic lupus erythematosus (SLE), a complex autoimmune disorder with multifactorial origins. It causes activation of T and B cells leading to autoantibody production. The pathogenesis involves genetic, hormonal and environmental factors interacting to cause immune dysregulation and failure of self-tolerance. SLE can affect many organ systems and presents with a variety of clinical manifestations involving the skin, kidneys, joints, blood, and more. Diagnosis is based on identifying 4 out of 11 diagnostic criteria. Investigations help assess disease activity and organ involvement. Treatment involves immunosuppression with corticosteroids and other drugs depending on disease severity and organ involvement.
The patient is a 60-year-old female who presented with a 2-year history of difficulty swallowing solid foods and dryness of the mouth and eyes. Various tests were performed and she was found to have Sjogren's syndrome based on positive labial biopsy and serum autoantibodies. Sjogren's syndrome is a chronic autoimmune disease characterized by lymphocytic infiltration of the exocrine glands, predominantly affecting middle-aged women. The patient's symptoms, test results, and biopsy findings were consistent with a diagnosis of primary Sjogren's syndrome.
This document discusses fever of unknown origin (FUO). It begins by classifying FUO into categories like classical FUO and nosocomial FUO. It then discusses the epidemiology and common etiologies of FUO, which include infections, collagen vascular diseases, and malignancies. The diagnostic approach involves a thorough history, repeated physical exams, and diagnostic testing like blood tests, imaging, and biopsies. Empirical therapeutic drug trials can help diagnose certain conditions but have limitations. The prognosis depends on the underlying cause, with poorer outcomes seen in elderly patients or those with neoplasms or diagnostic delays.
A 49-year-old female PLHA presented with a rapidly enlarging swelling on the right side of her neck over the past 9 months. FNAC and biopsy results showed findings suggestive of lymphoma. She was diagnosed with NHL stage 1 on the right side of the neck and WHO stage 4. Treatment options including chemotherapy first versus starting HAART first were discussed, along with using chemotherapy and HAART simultaneously or treating any OIs first before starting HAART. Sea vegetables were also discussed as a potential complementary treatment due to their anti-cancer properties.
Sepsis is a life-threatening condition that can develop from an infection. It occurs when the body's response to an infection damages its own tissues. The document discusses sepsis in children, including definitions, epidemiology, pathophysiology, clinical features, investigations, treatment guidelines, and future directions. Mortality from sepsis is high in developing countries, around 50% compared to 2-10% in industrialized nations. Young infants, especially those born premature or with low birth weight, are most at risk. Timely treatment of infection source and administration of antibiotics and fluids can help reduce mortality from this condition.
approach to a bleeding child with blood disorders.pptxtsholanangmaoka
This document describes the approach to three cases of bleeding in children. Case 1 involves a 5-month-old male with intracranial bleeding and seizures who was found to have a subdural hematoma requiring surgery. Despite resuscitation efforts, the child did not survive the surgery. Case 2 is a 2-year-old male with bruising and a very low platelet count, consistent with thrombocytopenia. Case 3 involves a 1-year-old male with knee swelling and fever, who was found to have a low platelet count, consistent with disseminated intravascular coagulation. The document provides definitions of types of bleeding, the stages of hemostasis, differential diagnoses, and management strategies for bleeding
This document provides an overview of sepsis in children. It defines sepsis and septic shock, noting that sepsis is a clinical syndrome complicating severe infection characterized by systemic inflammatory response, immune dysregulation, microcirculatory derangements, and potential end organ dysfunction. It discusses epidemiology, noting sepsis is a leading cause of child mortality worldwide. Presentation and pathophysiology are described. Etiology depends on factors like age and site of infection. Investigations and common lab abnormalities in septic shock are also outlined.
This document describes a case of Fournier's gangrene in a 43-year-old man. The patient presented with flu-like symptoms but upon examination was found to have necrotic scrotal tissue with surrounding erythema and crepitus, indicating necrotizing fasciitis. Treatment for Fournier's gangrene requires aggressive antibiotic therapy, early and repeated surgical debridement of necrotic tissue, and wound care. Scores like LRINEC and FGSI can help predict patient prognosis and risk of mortality from this rare but life-threatening infection.
Hydatid cysts are most commonly found in the liver and lungs, although they may also occur in other organs, bones and muscles. The cysts can increase in size to 5 – 10 cm or more and may survive for decades. Non-specific signs include loss of appetite, weight loss and weakness
Echinococcus granulosus sensu lato occurs practically worldwide, and more frequently in rural, grazing areas where dogs ingest organs from
diagnosis
epidemiology
managment
Approch to Hematuria in pediatric age groupMohammed Saadi
The document defines hematuria and its types, identifies common causes like UTIs and glomerulonephritis, and outlines the approach to evaluating and managing a patient with hematuria. This involves taking a thorough history, conducting a physical exam, ordering urine and blood tests to identify the cause, and treating any underlying conditions found like cystitis, pyelonephritis, or acute glomerulonephritis. Imaging tests may also be used to identify issues like stones, tumors, or structural abnormalities.
This document summarizes tubulointerstitial nephritis (TIN). It begins with questions about drug-induced acute TIN (ATIN). It then describes a case of suspected amoxicillin-induced ATIN in a 5-year old girl. The next question concerns management and follow-up of a boy with nonoliguric AKI and biopsy-proven severe interstitial inflammation treated with corticosteroids. The document goes on to define TIN and classify it as primary or secondary, acute or chronic. It discusses etiologies, pathophysiology, clinical features, investigations, treatment including corticosteroids, and prognosis of ATIN and chronic TIN. Specific conditions
This document provides an outline for a course on childhood acute lymphoblastic leukemia (ALL). It covers the definition and epidemiology of ALL, risk factors, clinical presentation, diagnosis, management including treatment phases, complications, prognosis, and prevention. ALL is the most common childhood cancer characterized by excessive lymphoblasts. It peaks between ages 2-3 and has a survival rate over 85% with current treatments over 2-3 years consisting of induction, intensification, and maintenance chemotherapy, along with intrathecal therapy targeting the central nervous system. Complications can include tumor lysis syndrome, infections, and secondary cancers. Prognosis depends on risk factors like age and white blood cell count. Prevention focuses on limiting environmental exposures like benz
Interactive talk on common hematological and oncological emergencies - which if not noticed early can lead to irreversible complications and death .
Intended to be used for educational purposes for the fertile minds in medicine .
This document discusses the case of a 5 month old female infant who presented with failure to suck, vomiting, abnormal body movements, and an increasing head circumference. She was born prematurely at 36 weeks gestation and had a history of neonatal meningitis treated with antibiotics. Imaging showed hydrocephalus and a brain abscess. She underwent EVD placement, craniotomy for abscess drainage, and was treated with antibiotics. Serial imaging showed complex hydrocephalus and residual abscesses. The discussion covers neonatal meningitis, its complications including brain abscess and hydrocephalus, typical organisms, presentations, imaging findings, and management.
The document provides information about acute appendicitis including:
1. Appendicitis is an inflammation of the appendix and remains a common acute surgical condition. It has a lifetime occurrence of approximately 12% in men and 25% in women.
2. The cause is unclear but obstruction is thought to play a main role by causing inflammation. This can lead to perforation or gangrene if not treated.
3. The diagnosis is typically based on the patient's history and symptoms of abdominal pain migrating to the lower right quadrant, as well as signs on examination like tenderness at McBurney's point. Imaging studies like CT scans can help diagnose unclear cases.
1. New diagnostic criteria have been developed to clarify the diagnosis of Sjogren's syndrome and diminish confusion in clinical practice and research.
2. The diagnosis of Sjogren's syndrome can be challenging as minor salivary gland biopsies and ANA blood tests sometimes have variable or non-specific results.
3. While Sjogren's syndrome and SLE share some similarities, Sjogren's syndrome has distinct clinical manifestations and treatment considerations compared to SLE.
The document discusses two conditions: paroxysmal nocturnal hemoglobinuria (PNH) and atypical hemolytic uremic syndrome (aHUS). PNH is a complement-mediated hemolytic anemia treated with the drug eculizumab, a C5a inhibitor. aHUS is a complement-mediated thrombotic microangiopathy that can cause stroke, heart attack, and kidney failure, and is also treated with eculizumab. The document asks the reader to identify PNH, aHUS, and the mode of action of eculizumab.
Walmart Business+ and Spark Good for Nonprofits.pdfTechSoup
"Learn about all the ways Walmart supports nonprofit organizations.
You will hear from Liz Willett, the Head of Nonprofits, and hear about what Walmart is doing to help nonprofits, including Walmart Business and Spark Good. Walmart Business+ is a new offer for nonprofits that offers discounts and also streamlines nonprofits order and expense tracking, saving time and money.
The webinar may also give some examples on how nonprofits can best leverage Walmart Business+.
The event will cover the following::
Walmart Business + (https://business.walmart.com/plus) is a new shopping experience for nonprofits, schools, and local business customers that connects an exclusive online shopping experience to stores. Benefits include free delivery and shipping, a 'Spend Analytics” feature, special discounts, deals and tax-exempt shopping.
Special TechSoup offer for a free 180 days membership, and up to $150 in discounts on eligible orders.
Spark Good (walmart.com/sparkgood) is a charitable platform that enables nonprofits to receive donations directly from customers and associates.
Answers about how you can do more with Walmart!"
Tuberculosis of the spine is the likely diagnosis here. The incubation period is usually 2 years. The commonest site is the thoracolumbar area which is an area of maximum stress and has valveless venous drainage.
- An 8-year-old male presented with dark brown urine, facial puffiness, abdominal pain, back pain, and decreased urine output over the past 2 days. Exam found mild periorbital edema and diffuse abdominal tenderness.
- Based on the history of a recent sore throat and positive streptococcal infection markers, the most likely diagnosis is poststreptococcal glomerulonephritis (PSGN).
- Investigations to consider include a complete blood count, basic metabolic panel, urinalysis with microscopy to look for red or white blood cell casts, and measurement of complement levels C3 and C4.
This document discusses systemic lupus erythematosus (SLE), a complex autoimmune disorder with multifactorial origins. It causes activation of T and B cells leading to autoantibody production. The pathogenesis involves genetic, hormonal and environmental factors interacting to cause immune dysregulation and failure of self-tolerance. SLE can affect many organ systems and presents with a variety of clinical manifestations involving the skin, kidneys, joints, blood, and more. Diagnosis is based on identifying 4 out of 11 diagnostic criteria. Investigations help assess disease activity and organ involvement. Treatment involves immunosuppression with corticosteroids and other drugs depending on disease severity and organ involvement.
The patient is a 60-year-old female who presented with a 2-year history of difficulty swallowing solid foods and dryness of the mouth and eyes. Various tests were performed and she was found to have Sjogren's syndrome based on positive labial biopsy and serum autoantibodies. Sjogren's syndrome is a chronic autoimmune disease characterized by lymphocytic infiltration of the exocrine glands, predominantly affecting middle-aged women. The patient's symptoms, test results, and biopsy findings were consistent with a diagnosis of primary Sjogren's syndrome.
This document discusses fever of unknown origin (FUO). It begins by classifying FUO into categories like classical FUO and nosocomial FUO. It then discusses the epidemiology and common etiologies of FUO, which include infections, collagen vascular diseases, and malignancies. The diagnostic approach involves a thorough history, repeated physical exams, and diagnostic testing like blood tests, imaging, and biopsies. Empirical therapeutic drug trials can help diagnose certain conditions but have limitations. The prognosis depends on the underlying cause, with poorer outcomes seen in elderly patients or those with neoplasms or diagnostic delays.
A 49-year-old female PLHA presented with a rapidly enlarging swelling on the right side of her neck over the past 9 months. FNAC and biopsy results showed findings suggestive of lymphoma. She was diagnosed with NHL stage 1 on the right side of the neck and WHO stage 4. Treatment options including chemotherapy first versus starting HAART first were discussed, along with using chemotherapy and HAART simultaneously or treating any OIs first before starting HAART. Sea vegetables were also discussed as a potential complementary treatment due to their anti-cancer properties.
Sepsis is a life-threatening condition that can develop from an infection. It occurs when the body's response to an infection damages its own tissues. The document discusses sepsis in children, including definitions, epidemiology, pathophysiology, clinical features, investigations, treatment guidelines, and future directions. Mortality from sepsis is high in developing countries, around 50% compared to 2-10% in industrialized nations. Young infants, especially those born premature or with low birth weight, are most at risk. Timely treatment of infection source and administration of antibiotics and fluids can help reduce mortality from this condition.
approach to a bleeding child with blood disorders.pptxtsholanangmaoka
This document describes the approach to three cases of bleeding in children. Case 1 involves a 5-month-old male with intracranial bleeding and seizures who was found to have a subdural hematoma requiring surgery. Despite resuscitation efforts, the child did not survive the surgery. Case 2 is a 2-year-old male with bruising and a very low platelet count, consistent with thrombocytopenia. Case 3 involves a 1-year-old male with knee swelling and fever, who was found to have a low platelet count, consistent with disseminated intravascular coagulation. The document provides definitions of types of bleeding, the stages of hemostasis, differential diagnoses, and management strategies for bleeding
This document provides an overview of sepsis in children. It defines sepsis and septic shock, noting that sepsis is a clinical syndrome complicating severe infection characterized by systemic inflammatory response, immune dysregulation, microcirculatory derangements, and potential end organ dysfunction. It discusses epidemiology, noting sepsis is a leading cause of child mortality worldwide. Presentation and pathophysiology are described. Etiology depends on factors like age and site of infection. Investigations and common lab abnormalities in septic shock are also outlined.
This document describes a case of Fournier's gangrene in a 43-year-old man. The patient presented with flu-like symptoms but upon examination was found to have necrotic scrotal tissue with surrounding erythema and crepitus, indicating necrotizing fasciitis. Treatment for Fournier's gangrene requires aggressive antibiotic therapy, early and repeated surgical debridement of necrotic tissue, and wound care. Scores like LRINEC and FGSI can help predict patient prognosis and risk of mortality from this rare but life-threatening infection.
Hydatid cysts are most commonly found in the liver and lungs, although they may also occur in other organs, bones and muscles. The cysts can increase in size to 5 – 10 cm or more and may survive for decades. Non-specific signs include loss of appetite, weight loss and weakness
Echinococcus granulosus sensu lato occurs practically worldwide, and more frequently in rural, grazing areas where dogs ingest organs from
diagnosis
epidemiology
managment
Approch to Hematuria in pediatric age groupMohammed Saadi
The document defines hematuria and its types, identifies common causes like UTIs and glomerulonephritis, and outlines the approach to evaluating and managing a patient with hematuria. This involves taking a thorough history, conducting a physical exam, ordering urine and blood tests to identify the cause, and treating any underlying conditions found like cystitis, pyelonephritis, or acute glomerulonephritis. Imaging tests may also be used to identify issues like stones, tumors, or structural abnormalities.
This document summarizes tubulointerstitial nephritis (TIN). It begins with questions about drug-induced acute TIN (ATIN). It then describes a case of suspected amoxicillin-induced ATIN in a 5-year old girl. The next question concerns management and follow-up of a boy with nonoliguric AKI and biopsy-proven severe interstitial inflammation treated with corticosteroids. The document goes on to define TIN and classify it as primary or secondary, acute or chronic. It discusses etiologies, pathophysiology, clinical features, investigations, treatment including corticosteroids, and prognosis of ATIN and chronic TIN. Specific conditions
This document provides an outline for a course on childhood acute lymphoblastic leukemia (ALL). It covers the definition and epidemiology of ALL, risk factors, clinical presentation, diagnosis, management including treatment phases, complications, prognosis, and prevention. ALL is the most common childhood cancer characterized by excessive lymphoblasts. It peaks between ages 2-3 and has a survival rate over 85% with current treatments over 2-3 years consisting of induction, intensification, and maintenance chemotherapy, along with intrathecal therapy targeting the central nervous system. Complications can include tumor lysis syndrome, infections, and secondary cancers. Prognosis depends on risk factors like age and white blood cell count. Prevention focuses on limiting environmental exposures like benz
Interactive talk on common hematological and oncological emergencies - which if not noticed early can lead to irreversible complications and death .
Intended to be used for educational purposes for the fertile minds in medicine .
This document discusses the case of a 5 month old female infant who presented with failure to suck, vomiting, abnormal body movements, and an increasing head circumference. She was born prematurely at 36 weeks gestation and had a history of neonatal meningitis treated with antibiotics. Imaging showed hydrocephalus and a brain abscess. She underwent EVD placement, craniotomy for abscess drainage, and was treated with antibiotics. Serial imaging showed complex hydrocephalus and residual abscesses. The discussion covers neonatal meningitis, its complications including brain abscess and hydrocephalus, typical organisms, presentations, imaging findings, and management.
The document provides information about acute appendicitis including:
1. Appendicitis is an inflammation of the appendix and remains a common acute surgical condition. It has a lifetime occurrence of approximately 12% in men and 25% in women.
2. The cause is unclear but obstruction is thought to play a main role by causing inflammation. This can lead to perforation or gangrene if not treated.
3. The diagnosis is typically based on the patient's history and symptoms of abdominal pain migrating to the lower right quadrant, as well as signs on examination like tenderness at McBurney's point. Imaging studies like CT scans can help diagnose unclear cases.
1. New diagnostic criteria have been developed to clarify the diagnosis of Sjogren's syndrome and diminish confusion in clinical practice and research.
2. The diagnosis of Sjogren's syndrome can be challenging as minor salivary gland biopsies and ANA blood tests sometimes have variable or non-specific results.
3. While Sjogren's syndrome and SLE share some similarities, Sjogren's syndrome has distinct clinical manifestations and treatment considerations compared to SLE.
The document discusses two conditions: paroxysmal nocturnal hemoglobinuria (PNH) and atypical hemolytic uremic syndrome (aHUS). PNH is a complement-mediated hemolytic anemia treated with the drug eculizumab, a C5a inhibitor. aHUS is a complement-mediated thrombotic microangiopathy that can cause stroke, heart attack, and kidney failure, and is also treated with eculizumab. The document asks the reader to identify PNH, aHUS, and the mode of action of eculizumab.
Walmart Business+ and Spark Good for Nonprofits.pdfTechSoup
"Learn about all the ways Walmart supports nonprofit organizations.
You will hear from Liz Willett, the Head of Nonprofits, and hear about what Walmart is doing to help nonprofits, including Walmart Business and Spark Good. Walmart Business+ is a new offer for nonprofits that offers discounts and also streamlines nonprofits order and expense tracking, saving time and money.
The webinar may also give some examples on how nonprofits can best leverage Walmart Business+.
The event will cover the following::
Walmart Business + (https://business.walmart.com/plus) is a new shopping experience for nonprofits, schools, and local business customers that connects an exclusive online shopping experience to stores. Benefits include free delivery and shipping, a 'Spend Analytics” feature, special discounts, deals and tax-exempt shopping.
Special TechSoup offer for a free 180 days membership, and up to $150 in discounts on eligible orders.
Spark Good (walmart.com/sparkgood) is a charitable platform that enables nonprofits to receive donations directly from customers and associates.
Answers about how you can do more with Walmart!"
This slide is special for master students (MIBS & MIFB) in UUM. Also useful for readers who are interested in the topic of contemporary Islamic banking.
How to Add Chatter in the odoo 17 ERP ModuleCeline George
In Odoo, the chatter is like a chat tool that helps you work together on records. You can leave notes and track things, making it easier to talk with your team and partners. Inside chatter, all communication history, activity, and changes will be displayed.
ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
Denis is a dynamic and results-driven Chief Information Officer (CIO) with a distinguished career spanning information systems analysis and technical project management. With a proven track record of spearheading the design and delivery of cutting-edge Information Management solutions, he has consistently elevated business operations, streamlined reporting functions, and maximized process efficiency.
Certified as an ISO/IEC 27001: Information Security Management Systems (ISMS) Lead Implementer, Data Protection Officer, and Cyber Risks Analyst, Denis brings a heightened focus on data security, privacy, and cyber resilience to every endeavor.
His expertise extends across a diverse spectrum of reporting, database, and web development applications, underpinned by an exceptional grasp of data storage and virtualization technologies. His proficiency in application testing, database administration, and data cleansing ensures seamless execution of complex projects.
What sets Denis apart is his comprehensive understanding of Business and Systems Analysis technologies, honed through involvement in all phases of the Software Development Lifecycle (SDLC). From meticulous requirements gathering to precise analysis, innovative design, rigorous development, thorough testing, and successful implementation, he has consistently delivered exceptional results.
Throughout his career, he has taken on multifaceted roles, from leading technical project management teams to owning solutions that drive operational excellence. His conscientious and proactive approach is unwavering, whether he is working independently or collaboratively within a team. His ability to connect with colleagues on a personal level underscores his commitment to fostering a harmonious and productive workplace environment.
Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
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Find out more about ISO training and certification services
Training: ISO/IEC 27001 Information Security Management System - EN | PECB
ISO/IEC 42001 Artificial Intelligence Management System - EN | PECB
General Data Protection Regulation (GDPR) - Training Courses - EN | PECB
Webinars: https://pecb.com/webinars
Article: https://pecb.com/article
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For more information about PECB:
Website: https://pecb.com/
LinkedIn: https://www.linkedin.com/company/pecb/
Facebook: https://www.facebook.com/PECBInternational/
Slideshare: http://www.slideshare.net/PECBCERTIFICATION
How to Setup Warehouse & Location in Odoo 17 InventoryCeline George
In this slide, we'll explore how to set up warehouses and locations in Odoo 17 Inventory. This will help us manage our stock effectively, track inventory levels, and streamline warehouse operations.
How to Build a Module in Odoo 17 Using the Scaffold MethodCeline George
Odoo provides an option for creating a module by using a single line command. By using this command the user can make a whole structure of a module. It is very easy for a beginner to make a module. There is no need to make each file manually. This slide will show how to create a module using the scaffold method.
How to Manage Your Lost Opportunities in Odoo 17 CRMCeline George
Odoo 17 CRM allows us to track why we lose sales opportunities with "Lost Reasons." This helps analyze our sales process and identify areas for improvement. Here's how to configure lost reasons in Odoo 17 CRM
हिंदी वर्णमाला पीपीटी, hindi alphabet PPT presentation, hindi varnamala PPT, Hindi Varnamala pdf, हिंदी स्वर, हिंदी व्यंजन, sikhiye hindi varnmala, dr. mulla adam ali, hindi language and literature, hindi alphabet with drawing, hindi alphabet pdf, hindi varnamala for childrens, hindi language, hindi varnamala practice for kids, https://www.drmullaadamali.com
1. Signalment:
Eight-year-old, male-neutered, domestic shorthair cat
Clinical history:
Presented with a 6-week history of non-productive sneezing and a one week of right-sided facial
swelling. They had recently been administered a short course of amoxicillin-clavulanate, but the
response to this was equivocal.
On further questioning, they also had a 12-months history of progressive weight loss, with reduced
appetite and possibly increased thirst. They had outdoor access, so their frequency and volume of
urination was unknown.
They were up to date with vaccinations, given topical Frontline (fipronil) intermittently, and given a
Milbemax wormer (milbemycin oxime; praziquantel) at time of vaccination. There was no history of
travel outside the UK.
QUESTION 1: What are your problems? What are your differentials (what is most likely)?
What do you want to do next (and how much will that cost)? > Go to next page for answers
Case example 1
Physical examination:
They had a non-painful, right-sided, soft-tissue, facial swelling extending caudally from the nasal planum to the orbit, and from the midline
to the right lateral canthus (see photo). They had protrusion of the third eyelid and an enlarged right submandibular lymph node, both on
the right. They had bilateral nasal airflow.
They were in thin body condition (body condition score 3/9).
Clinical examination was otherwise unremarkable.
2. QUESTION 1: What are your problems?
ANSWER:
• Major concerns
o Six-week history of non-productive sneezing
o One-week history of unilateral facial swelling
o Enlarged sub-mandibular lymph node
• Minor concerns
o One-year history of reduced appetite ( weight loss / thin condition) / increased thirst that was
progressive
o Third-eyelid protrusion
o Recently received antimicrobials – unknown response
QUESTION 2: What are your differentials?
> Go to next page for answers
3. QUESTION 2: What are your differentials?
ANSWER:
• Sneezing
o Infection – viral (e.g. feline herpesvirus (FHV-1); fungal (e.g. Cryptococcus); bacterial
o Foreign body
o Dental disease
o Environmental irritation
• Unilateral facial swelling
o Superficial disease
Infection (abscess or cellulitis) – bacterial (e.g. cat fight injuries); fungal
Inflammation – allergic (e.g. insect sting)
Trauma
Haematoma
o Orbital disease
Conjunctivitis
o Extension of disease from the nasal cavity / sinus
Infection – bacterial; fungal
Neoplasia
> Answer continued on next page
Notes: Due to the shared timeframe – the sneezing and facial swelling are likely
related. This makes invasive disease (neoplasia; deep infection) most likely
4. QUESTION 3: What do you want to do next? > Go to next page for answers
… continued… QUESTION 2: What are your differentials?
Whilst, we tend to focus on the major / acute problems, considering the minor issues can sometimes raise the suspicions of differentials for the major problem. It also
highlights areas we might want to assess before proceeding to more invasive procedures.
Reduced appetite
o Oral / dental disease
o Gastrointestinal disease
o Systemic disease e.g. chronic kidney disease; apathetic hyperthyroidism; cholangitis; pancreatitis
o Reduced sense of smell
Increased thirst
o Chronic kidney disease
o Hyperthyroidism
o Diabetes mellitus
o Increased gastrointestinal losses
o Electrolyte disturbances
Third eyelid protrusion
o Orbital disease
o Neurological disease (e.g. middle ear disease)
Enlarged lymph node
o Inflammation – e.g. reactive (i.e. to inflammation of tissues that drain into it)
o Neoplasia – primary (e.g. lymphoma); metastatic (i.e. from tissues that drain into it)
Notes: Due to the shared timeframe – the reduced appetite and increased thirst are most likely related, and can be considered in combination (e.g. consider your
differential list for polydipsia and prioritise those that also reduce appetite, whilst lowering, but not removing the differentials that often cause increased appetite). The
weight loss and thin condition can also be considered a function of the reduced appetite. Unlikely that diabetes has been present for a year without having a crisis, but
there could be compound issues happening.
The enlarged lymph node is likely related to the facial swelling as on the same side – but that fits with both neoplasia and infection!
5. QUESTION 3: What do you want to do next?
ANSWER
Haematology – looking for evidence of inflammation or systemic disease
Serum biochemistry – looking for evidence of inflammation or systemic disease; checking for chronic kidney disease,
hyperthyroidism, diabetes mellitus, electrolyte disturbances etc.
Urinalysis – looking for evidence of reduced urine concentrating ability (e.g. to support increased renal losses as a cause of the
polydipsia), and to check for diabetes mellitus
Clotting screen – check for coagulopathy (preferable, before inducing epistaxis! But, as no history of epistaxis / haemorrhage,
could be optional if finances are limited)
Respiratory virus screen (FHV-1 PCR and feline calicivirus (FCV) RT-PCR)
Cryptococcus antigen serology (optional, could pend other diagnostics e.g. histology or cytology)
Retrovirus screen (optional, but sensible in a sick, older cat)
Fine needle aspirate cytology
o Lymph node
o Facial swelling
Diagnostic imaging – CT head
Endoscopy – rhinoscopy with biopsy
Estimate to get an answer (i.e. does not include treatment) £3500
> Go to next page for test results
7. Investigation (continued)
Urinalysis (collected by cystocentesis)
pH 6.7
Protein creatinine ratio 0.21
Specific gravity 1.022
Dipstick Blood ++
Glucose negative
Ketones negative
Sediment examination Unremarkable
Culture Negative
Infectious disease screening
Respiratory virus screen – negative for FHV-
1 and FCV by PCR / RT-PCR
Cryptococcus antigen serology – negative
Retrovirus screen – FIV antibody negative;
FeLV antigen negative
Fine needle aspirate cytology
Sub-mandibular lymph node were possible
conscious:
Description: Mixed population of
predominantly small lymphocytes, with
scattering of plasma cells and neutrophils. No
organisms seen.
Comment: Consistent with immune stimulation
Facial swelling not attempted whilst conscious
QUESTION 4: What do you think is going on? What do you want to do next (i.e. have these results changed your
investigation plan)?
> Go to next page for answers
8. QUESTION 4: What do you think is going on? What do you want to do next (i.e. have these results changed your
investigation plan)?
ANSWER:
Preliminary Conclusions & treatment
Conclusions
There is evidence of kidney disease, most likely chronic given the history. Due to the reduced body condition the creatinine value
likely underestimated the degree of compromise. Concurrent diabetes mellitus and hyperthyroidism have been ruled out.
Kidney disease combined with fasting prior to blood sampling likely account for the slightly low potassium. The
hyperglobulinaemia likely reflects a chronic inflammatory process, supported by the mature neutrophilia; however, a neoplastic
process could not be ruled out.
The lymph node cytology makes inflammation more likely and neoplasia less likely – but does not rule it out.
Common infectious causes of rhinitis (i.e. FHV-1; FCV) have been ruled out, as have common reasons for immune-suppression.
Initial treatment
The presence of kidney disease does not account for the facial swelling; however, it does impact on investigation and future
treatment. Further evaluation of the kidneys would now be indicated: measurement of blood pressure; abdominal
ultrasonography. Iodinated CT contrast agents have the potential to exacerbate kidney disease and cause acute kidney injury;
they are used only with caution in animals with known kidney compromise. In this case, potassium-supplemented fluid therapy
was administered prior to the anaesthetic to address any subclinical dehydration, a lower dose of contrast agent was used, and
the owner was warned of the potential risk.
9. Further investigation
CT imaging
• Head – revealed the following changes
o The right frontal sinus is fluid filled and
the overlying frontal bone is thinned at its
rostral limit, axial to the zygomatic
process of the frontal bone.
o There is mild swelling of the soft tissues
dorsal to the zygomatic arch on the right.
o The majority of the right nasal cavity is
filled with contrast-enhancing soft tissue.
o There is evidence of turbinate
destruction, and partial lysis of the right
naso-orbital wall (likely involving the
lacrimal, palatine and maxillary bones).
o Gas pockets are visible within the soft
tissues of both orbits (incidental).
o The right mandibular and right medial
retropharyngeal lymph nodes are
enlarged (7 mm and 8-10 mm
respectively).
• Thorax – was unremarkable > Test results continued on next page
ABOVE: CT images of the skull, viewed using a bone window (A) and a soft-tissue window pre-(B) and post-(C) contrast, immediately
rostral to the orbits. The contrast enhancing soft-tissue mass in the right nasal cavity is indicated (A; arrows), as is the bony
destruction lateral to the mass (A; arrow head)
A C
B
LEFT: CT image, viewed using a bone window, at the level of the
middle of the orbits revealing the fluid containing right frontal
sinus (arrow head)
10. Further investigation (continued)
Rhinoscopy
• Retroflexed rhinoscopy: the nasopharynx was slightly irregular with small undulations on the ventral surface
• Anterograde rhinoscopy: examination of the left nasal passage revealed a small amount of mucopurulent
discharge and slight hyperaemia of the mucosal surfaces. Examination of the right nasal passage revealed:
moderate amounts of purulent discharge; very irregular turbinates; and a large, pale, mass-lesion occupying the
dorsal and rostral nasal chamber.
Cytology
• Nasal flush: Scattered neutrophils made up the majority of the cells present. These were very poorly preserved.
There were also occasional large squamous epithelial cells, some with Simonsiella bacteria attached.
• Nasal biopsy impression smear: Across the smears there were very high numbers of nucleated cells and
moderated numbers of erythrocytes. The nucleated cells were predominantly (>90%) neutrophils, which
appeared somewhat ragged, with the vast majority of the remainder being ciliated columnar respiratory epithelial
cells. These showed moderate cytoplasmic basophilia, anisocytosis and anisokaryosis. There were occasional
binucleated examples. Occasional macrophages were also present. No organisms were noted.
Comment: Marked neutrophilic inflammation and accompanying dysplasia in the epithelium. The cause for the
inflammation is not evident.
> Test results continued on next page
11. Further investigation (continued)
Nasal Histopathology
• Right nasal biopsy: Where present, the surface is predominantly covered by pseudostratified, columnar, ciliated, (respiratory) epithelium.
Within the propria-submucosa there is patchy oedema and recent haemorrhage; vessels are generally congested and small vessels frequently
contain increased numbers of granulocytes. In addition, there is a patchy, moderate to focally marked increase in lymphocytes and plasma
cells with moderate infiltration by neutrophils. Portions of turbinate bone are present and appear normal. In one section, there is focal
deposition of amorphous to hyaline, birefringent, palely eosinophilic material within the propria-submucosa, but fails to stain with Congo red
(collagen). Adjacent to the surface of the sections there are aggregates of neutrophils, admixed with sloughed epithelial cells, free red blood
cells and a background of flocculent to wispy, eosinophilic material (mucus). Staining with PAS fails to identify the presence of fungi. A
separate section is presented on a second slide, and comprises an aggregate of neutrophils, admixed with free red blood cells, sloughed
epithelial cells and abundant finely granular, basophilic material that stains negatively with Gram, the appearance of which is suspicious of
Gram-negative bacteria. Staining with PAS fails to identify the presence of fungi.
• Left nasal biopsy: The sections comprise portions of nasal turbinate that are covered by respiratory epithelium. There is some oedema of
the propria-submucosa and small vessels are generally congested; there is patchy, mild infiltration of the propria-submucosa by neutrophils
and there are focal areas of deposition of a fibrillar, eosinophilic, birefringent extracellular matrix that fails to stain with Congo red (collagen).
The fragments comprise small portions of nasal turbinate; portions of squamous epithelium; aggregates of neutrophils that are admixed with
free red blood cells, and flocculent, eosinophilic material. Staining with PAS fails to identify the presence of fungi.
Comment: Within the sections collected from the right nasal cavity there is a patchy, moderate to focally severe rhinitis, comprising
lymphocytes, plasma cells and neutrophils, with evidence of exudation and in one section, a suspicion of Gram-negative bacteria. Within the
sections collected from the left nasal cavity there is a patchy, mild neutrophilic rhinitis. Within the sections collected from both nasal cavities
there are areas of deposition of collagen (fibrosis). There is no evidence of neoplasia or fungal infection in the sections examined.
> Test results continued on next page
12. Further investigation (continued)
Nasal biopsy culture (left and right)
Fungal culture: negative
Extended bacterial culture (aerobic and anaerobic):
negative
Serum protein electrophoresis
Revealed a polyclonal gammopathy
Abdominal ultrasound
Bilateral renal changes:
o Shrunken size (right kidney 27mm in length; left kidney
37mm in length)
o Irregular outline (considered secondary to multiple
chronic renal infarcts)
o Cortices were very hyperechoic, with poor
corticomedullary differentiation
o Faint corticomedullary rim sign
QUESTION 5: What do you think is going on? What do you want to do next? > Go to next page for answers
13. QUESTION 5: What do you think is going on? What do you want to do next?
ANSWER:
Follow-up conclusions, treatment & outcome
Follow-up conclusions
• Destructive, invasive nasal mass – biopsy revealed suspected suppurative neutrophilic rhinitis / turbinate
osteomyelitis, but culture was negative
• Chronic kidney disease – IRIS stage II; non-hypertensive; borderline proteinuric
Secondary bacterial infection is not uncommon during nasal disease – due to altered production and flow of mucus.
This explains the, often partial, response to antimicrobials – but the frequent recurrence when the antimicrobials are
discontinued. Combined with the low likelihood of primary nasal turbinate osteomyelitis, high likelihood of nasal
neoplasia in an older cat with nasal signs, and (unpublished) data that indicate ~ 1 in 3-4 companion animals with nasal
biopsies (performed by specialists) require repeat nasal biopsy in order to confirm the diagnosis, a missed diagnosis of
nasal neoplasia could not be ruled out. Further investigation (i.e. repeat biopsy) was declined by the client at that time.
The negative bacterial culture could have been due to the recent antimicrobials, and the lack of response due to the
shortness of the course administered.
> Answer continued on next page
14. QUESTION 5: What do you think is going on? What do you want to do next?
ANSWER:
Treatment & outcome
Chronic kidney disease likely accounted, at least in part, for the reduced appetite, increased thirst and weight loss.
They were managed with a renal support diet and monitored – as per the IRIS guidelines (www.iris-kidney.com)
The localised nasal infection may have also contributed to the reduced appetite. They were treated with a prolonged
(12 week) course of amoxicillin-clavulanate (12mg/kg; q8hrs) – for presumed osteomyelitis. The facial swelling resolved
and the sneezing ceased. Repeat imaging (2.5 months after the initial investigation) revealed absence of the mass,
resolution of the fluid accumulations, and normal draining lymph nodes. Nasal biopsy histology was consistent with
chronic lymphoplasmacytic rhinitis. Blood analysis revealed a resolution of the neutrophilia, an increase in the
haematocrit, a gradual reduction in the hyperglobulinaemia, and a gradual progression of the azotaemia (into IRIS
grade III). Clinical signs did not recur following completion of the antimicrobial course.